Surface immunoglobulin density in the differential diagnosis of B-cell chronic lymphocytic leukemia and leukemic immunocytoma

De-Novo B-Cell Prolymphocytic Leukemia

B-cell prolymphocytic leukemia (B-PLL) is a rare B-cell neoplasm that typically presents with splenomegaly, a rising white blood cell count, and may or may not have B symptoms. The diagnosis usually requires a bone marrow biopsy and aspirate with flow cytometry and cytogenetic studies. At least 55% of the lymphocytes in the peripheral blood must be prolymphocytes to be defined as B-PLL. A thorough differential diagnosis would include mantle cell lymphoma, chronic lymphocytic leukemia (CLL) with prolymphocytes, hairy cell leukemia, and splenic marginal zone lymphoma. B-PLL is managed with regimens utilized for CLL, such as ibrutinib and rituximab but is tailored for each individual. The authors report a rare case of B-PLL in a patient with no known history of CLL. The authors discuss this entity in context of the 2017 and 2022 World Health Organization (WHO) classifications, the latter of which no longer recognizes B-PLL as a distinct entity. The authors hope that this article helps practitioners with the diagnosis and treatment of B-PLL. Perhaps with better recognition, and better documentation of histopathologic features of these rare cases going forward, it may prove to be a distinct entity again in future classifications.

Clinical heterogeneity reflects biologic diversity in chronic lymphocytic leukemia

As the incidence of B cell chronic lymphocytic leukemia increases in an aging population, it becomes more important to re-evaluate our understanding of the disease process and current therapy. Previous treatment strategies have been, for the most part, unsuccessful in prolonging survival and thus new approaches are needed. More intense cellular and molecular research on the biologic diversity of this neoplasm will further our understanding of the causes of clinical heterogeneity and refine our ability to predict progression. New approaches, based on alterations of neoplastic cell growth by cytokines or chemotherapeutic agents, may enable clinicians to 'customize' individual treatments based on the stages of CLL B cell differentiation and our understanding of factors involved in the regulation of apoptosis and proliferation at those stages. Taken together, these efforts should ultimately yield much new information that will lead to reduced morbidity and mortality in B-CLL, the most common form of human leukemia.

Standardized multicentric quantimetry of differentiation antigens expression. The GEIL's approach in acute lymphoblastic leukemia. Groupe d'Etude Immunologique des Leucémies

The use of flow cytometry as a common tool has opened the field of quantimetric immunophenotyping. This could help refine the definition of leukemic proliferations, and perhaps provide new prognostic criteria. We investigated whether this approach could be applied to multicentric immunophenotyping. The reproducibility of quantitative measurements on different types of flow cytometers was tested using a single batch of calibrating and "blind" fluorescent beads. Less than 7% CV was obtained between 20 different laboratories. We then explored the variations noted with control or normal lymphocytes, using various CD4 monoclonal antibodies, which were found to be lower than 10%. We finally applied this strategy to acute lymphoblastic leukemias (ALL), performing quantitative measurements of CD10 using one single aliquoted batch of FITC-CD10 in comparison with locally used reagents. PreB-ALL could indeed be further stratified depending on the density of CD10 expression. Use of the same monoclonal antibody is however recommended, since PreB-ALL also seem to display epitopic variations of the CD10 molecule.